Provider Demographics
NPI:1932463478
Name:BALLAH-LEAHEY, DEDDEH M (MD)
Entity Type:Individual
Prefix:DR
First Name:DEDDEH
Middle Name:M
Last Name:BALLAH-LEAHEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DEDDEH
Other - Middle Name:
Other - Last Name:BALLAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:500 REDWOOD BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-6921
Mailing Address - Country:US
Mailing Address - Phone:401-481-7660
Mailing Address - Fax:
Practice Address - Street 1:5501 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3018
Practice Address - Country:US
Practice Address - Phone:215-456-8520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1203322085U0001X
CAA001293322085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound